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EHD LOG NUMBER <br /> } DATE RECEIVED SAN JOAQUIN COUNTY <br /> Fl1riCGj�'�� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3 Floor Stockton, CA 95205 <br /> G 3 X044 (209)468-3420 Fax- (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> JI��C�!Nti ; NAL PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSlAGENCY: r~�GEc1 (NL°► <br /> ADDRESS: 0- �C° w 'ti-rS �� 76 <br /> PHONE: U - !o FACSIMILE.—.2p9_1836- 667b ' <br /> ACSIMILE:..2U9_183S- 467b ' <br /> TENTATIVE*APPOINTMENT DATE: _ W Time:f` <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE.REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��� l l __ DATE 3 4 <br /> Department Use Only <br /> FILE ADDRESS UN(T <br /> t. Street Xa 0 a Unit 'I <br /> 2. strW cd OAJ <br /> 3. street N 13 -q,60-10 0 Unit 2 <br /> ty <br /> 4. Street G <br /> 5. Street <br /> c. Unlet 3 <br /> 6. Street G <br /> 7. Street C Unit 4 <br /> 6. Street C+ <br /> 9. Street city Unk r <br /> 10. Sweet ON <br /> s <br /> .-. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .F <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) USING ABATEMENT Cf—SOLID W FACILITY <br /> �ER CLEANUP,'SITE(NON-LOP) �OD FACILITY -!TSOLID WASTE VEHICLE <br /> ERGROUND TANK(MONITORiNGIREMOVAL) KENNEL �AIRY <br /> OUS WASTE GENERATOR mHICKEN RANCH �PKG TREATMENT PLANT <br /> RED PERMITTED FACILITY OTELIHOTEL '00_PJJMPERTRUCKrYARDICHEM TOILETS <br /> ,jdg ;rATTOOISODY PIERCING � UISPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> a <br /> 1. List up to ten addresses in the space above. Select the-type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense ' <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. _ _ <br /> 6. Applications received after 3:00 pm will be processed the next business day <br /> CONI=IRMED A'PDINTMENT.DATE TIME f <br /> DATACOhfFiRMAED. . PHONi= FAX. INITIALS <br /> REVIEWED YES NO ',. . REVIEW DATE , <br /> END 48-02-006 - <br /> &'=003 - <br /> j <br />